NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 45-year-old male presents with sudden onset of palpitations. He is alert and oriented, blood pressure 130/80 mmHg, heart rate 180 bpm, respirations 18 bpm, SpO2 98%. The ECG shows a regular narrow-complex tachycardia with no discernible P waves. What is the MOST appropriate initial intervention?
- ASynchronized cardioversion at 50 J.
- BAdminister diltiazem 0.25 mg/kg IV over 2 minutes.
- CPerform vagal maneuvers.
- DAdminister adenosine 6 mg IV rapid push.
Show answer & explanationAnswer & explanation
Correct answer: C. Perform vagal maneuvers.
The patient presents with stable narrow-complex tachycardia (likely SVT). The initial intervention for stable SVT is vagal maneuvers. If unsuccessful, adenosine would be the next step.
Why the other options are wrong
- A. Cardioversion is for unstable tachycardia or if medications fail in stable patients.
- B. Diltiazem is an alternative to adenosine for stable SVT, but vagal maneuvers are still tried first.
- D. Adenosine is the next step if vagal maneuvers are unsuccessful, but not the initial intervention.
Stable Narrow-Complex Tachycardia
A regular, fast heart rhythm originating above the ventricles, with a narrow QRS complex, where the patient maintains stable vital signs.
- Often Supraventricular Tachycardia (SVT).
- Initial treatment involves vagal maneuvers.
- Adenosine is the first-line pharmacological treatment if vagal maneuvers fail.
Memory trick: Stable SVT: 'Vagal' then 'Adenosine' and 'Don't Get Shocked'!